306005678-4-27-2023-22-AS-AORZ-CRNNXW-20230509105149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 04/27/2023
Date Signed: 04/27/2023 10:29:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2021 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20211115104247

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	PAUL BROWN		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 459-3353
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 148	DATE:	04/27/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Christine Chon		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff did not properly monitor a resident's medication while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation for the allegation listed above. LPA met with Executive Director (ED) Christine Chon. LPA explained the reason for the visit. The investigation revealed the following. It was alleged the facility staff did not properly monitor a resident's medication while in care. On 11/13/21 sometime in the morning around 8:00 am during the medication pass Resident 1 (R1) allegedly took 5 units of insulin instead of 3 in the presence of staff who knew this was the wrong dose and staff did not prevent R1 from taking the wrong dose. 911 was called and resident was transported to the hospital. The witnesses interviewed reported conflicting information, either 5 units of insulin were drawn up by R1 or 3 units of insulin were drawn up by R1. All witnesses agree R1 was transported to the hospital. It is unclear if R1 received any insulin on the morning of 11/13/21, all witnesses interviewed reported conflicting information. A review of records show that the facility manages R1’s medication except for; R1 tests their own glucose levels and administers their own insulin injections. R1 is prescribed 3 units of insulin (3mL). R1 was admitted to the hospital and treated for a UTI.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20211115104247

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE	FACILITY NUMBER: 306005678
	VISIT DATE: 04/27/2023

NARRATIVE

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R1 returned to the facility on 11/14/21. All witnesses interviewed corroborate this information. Staff reported that due to R1’s condition at the time and because they could not administer their own insulin properly, they called 911. It is unclear if R1 took any insulin on 11/13/21 and there is not enough evidence to determine how much insulin was drawn up for injection. What is clear is that staff were present and called 911. R1 was taken to the hospital and treated and released the next day. Based on the evidence gathered the allegation, staff did not properly monitor a resident's medication while in care is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

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